Cervical cancer is a major cause of death in women from areas of the world where medical resources are limited. Since the 1950’s women in the U.S. have been screened for cervical cancer with Pap smears. The Pap smear can detect early changes in the cervix and thus allows for timely medical interventions that can prevent the development of cancer. Dr. George Papanicolaou developed the test in the 1940’s, when it was literally a microscopic evaluation of stained smears of cervical mucus. For a decade or more, the test is now done on solutions of cervical cells that are evaluated automatically by specialized optical instruments.
Within the last ten years guidelines for the recommended frequency of Pap smears have changed. The reasons for this change include studies showing that annual screening is no better than screening every 3-5 years and that the human papilloma virus (HPV), which is the primary cause of cervical cancer, is frequently cleared by young women without any intervention.
Screening from age 21 to age 65
The main tests used in the U.S. for cervical cancer screening are the Pap smear and co-testing (simultaneous Pap smear and HPV testing). I (and Dr. Kanner) usually do the co-testing to allow less frequent screening. Current guidelines for cervical cancer screening for low-risk women who have never had HPV or an abnormal Pap and are asymptomatic are as follows:
- Screening should begin at age 21 for all women, even those who have had the HPV vaccine.
- Age 21-29 Pap smear alone every 3 years.
- Age >30 to 65 Pap smear every 3 years or co-testing every 5 years.
- Pap smears should be stopped in women who have had a hysterectomy with removal of the cervix for a benign condition.
Stopping Paps at 65 for low-risk women
Most experts believe that Pap smears can be stopped at age 65 so long as a woman meets the following criteria:
- – never smoked
- – no new partner since the last Pap
- – adequate previous screenings
- – no history of HPV or abnormal Pap
- – no DES exposure
- – does not have HIV and is not immunocompromised
What about high-risk women?
Women with a history of an abnormal Pap smear with high grade dysplasia need follow-up screening for at least 20 years after the abnormality, even if this requires screening past the age of 65. If an abnormal Pap smear is obtained, HPV status is checked. If a high risk HPV virus is detected, further workup including evaluating the cervix with direct visualization (colposcopy) and additional testing or biopsies may be recommended. These are done by our gynecology colleagues.
Please remember that Pap smears screen only for cervical and not for other gynecologic cancers, such as uterine or ovarian cancer. There still are no effective screening procedures for those cancers.
Contact us if you have further questions or to set up a Pap smear if you are overdue.